Altitude is the whole trip

Everything about travelling in Tibet is planning around altitude. Lhasa sits at 3,650 m. The road to Everest Base Camp tops out above 5,200 m. Most travellers who have a bad Tibet trip do not have it because of permits or politics. They have it because they tried to do too much on day two.

I have guided several trips here and I have learned that the itinerary matters less than the pace. Here is what actually helps.

How altitude affects people, honestly

At 3,650 m there is roughly 40 percent less oxygen in each breath than at sea level. Some people feel almost nothing. Some people feel like they have flu for two days.

The common symptoms on arrival in Lhasa are headache, poor sleep, breathlessness on stairs, and loss of appetite. Those are normal for the first 24 to 48 hours and they usually pass. The symptoms that should worry you are different: a wet cough, confusion, breathlessness while resting, or vomiting that will not stop. Those mean descending and getting medical help, not pushing on.

Fitness is not protection. I have watched marathon runners struggle while an unfit 60-year-old was fine. Nobody can predict their own response.

The first 48 hours in Lhasa

This is the part people get wrong. Lhasa is not a city where you tick off sights on arrival day.

Day one

Arrive, check in, and do almost nothing. A short walk around the immediate neighbourhood, a light meal, and an early night. Do not nap for four hours in the afternoon; it makes the first night's sleep worse.

Drink more water than feels necessary. Two to three litres over the day. Avoid alcohol entirely for the first 48 hours, and go easy on caffeine.

Day two

Still slow. Jokhang Temple and the Barkhor circuit are at 3,650 m and involve standing for a couple of hours. That is enough. Do not add the Potala Palace on the same day.

A decent day two looks like: morning at Jokhang and the Barkhor, long lunch, rest in the afternoon, short walk at dusk.

Day three

Now do the Potala Palace. It involves a long climb up stone stairs, several hundred steps, at altitude. Budget two hours with rests. The timed entry system means you will have a slot; take an afternoon slot if you can, so you are not climbing first thing.

What actually helps

• Water, constantly. Dehydration at altitude feels exactly like altitude sickness and is far more common.
• Slow your walking pace by about a third. You will feel self-conscious. Do it anyway.
• Skip the stairs when you can. Lifts exist in most Lhasa hotels and in parts of the Potala complex.
• Eat light but regularly. Carbohydrates are easier than heavy meat dishes at altitude.
• Sleep propped up slightly. It helps breathing at night.

What does not help, in my experience

The oxygen canisters sold on every corner in Lhasa are mostly a comfort object. They give you a few minutes of relief and can create a dependency feeling where people panic without one. I do not carry them.

Strong sedatives for sleep are a bad idea at altitude, because they suppress breathing. Ask a doctor about acetazolamide before you travel rather than self-medicating on arrival.

Going higher: what changes

If you are continuing on the Friendship Highway toward Shigatse, Sakya, and Everest Base Camp, each stage matters.

• Shigatse is 3,850 m, barely higher than Lhasa. It is a good acclimatisation stop, not a challenge.
• Sakya and the passes on the way to EBC cross 4,500 to 5,200 m. These are day crossings, which is much easier than sleeping there.
• Everest Base Camp at 5,200 m is a short visit for most travellers, an hour or two, then back down to sleep lower at around 4,200 m at Rongbuk or lower in the valley. Sleeping high is what causes trouble; visiting high briefly is usually fine.

If you are going to EBC, you want a minimum of three to four nights at altitude before you get there. Not negotiable.

What to pack that nobody mentions

• Lip balm and heavy moisturiser. The air is dry in a way that surprises people. Skin cracks within days.
• Sunglasses rated properly, not fashion glasses. UV at 5,000 m is serious.
• A wide-brimmed hat and high-factor sunscreen for nose and ears.
• Layers rather than one heavy coat. Temperature swings of 20°C between sun and shade are routine.
• Your own supply of any medicine you use, in original packaging with the prescription. Pharmacies in Tibet stock less than you would expect.
• A small packet of tissues. Public toilets frequently have no paper.

An itinerary that actually works

For a seven-night trip, this is the structure I would use:

• Days 1 to 3: Lhasa, arriving and acclimatising, Jokhang and Barkhor on day two, Potala on day three.
• Day 4: Sera and Drepung monasteries, still in Lhasa.
• Day 5: Drive toward Shigatse over the passes. Long day, high points, but you sleep at 3,850 m.
• Day 6: Shigatse to the Everest region. Cross high passes, sleep lower.
• Day 7: Base Camp early, then drive back down.
• Day 8: Return to Lhasa by air or road.

That is compressed but workable for a fit traveller with three acclimatisation days behind them. If you have ten nights, add two more in Lhasa and one in Shigatse and the whole trip gets noticeably easier.

The honest summary

Tibet rewards patience and punishes itineraries. The travellers who have the best time are the ones who accept that day one is for doing nothing, that day two is for doing a little, and that the mountains will still be there on day five.

Book the permits early, build in the slow days, and treat the first 48 hours as part of the trip rather than a delay to it.

Originally published on 71Asia Tours blog.